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CLINICAL STUDY

The regulation and measurement of plasma volume in heart failure

Paul R. Kalra, MA, MRCP^*,*, Constantinos Anagnostopoulos, MD, PhD, FESC, Aidan P. Bolger, BSc, MRCP^*, Andrew J. S. Coats, DM, FACC^* and Stefan D. Anker, MD, PhD^*

^* Clinical Cardiology, National Heart and Lung Institute, London, United Kingdom
Department of Nuclear Medicine, Royal Brompton Hospital, London, United Kingdom
Department of Cardiology, Franz-Volhard-Klinik (Charité, Campus Berlin-Buch) at Max Delbrück Centrum for Molecular Medicine, Berlin, Germany

Manuscript received November 29, 2001; revised manuscript received March 19, 2002, accepted April 3, 2002.

^* Reprint requests and correspondence: Dr. Paul Kalra, Clinical Cardiology, National Heart and Lung Institute, Dovehouse Street, London SW3 6LY, United Kingdom.
p.kalra{at}ic.ac.uk

Plasma volume, the intravascular portion of the extracellular fluid volume, can be measured using standard dilution techniques with radiolabeled tracer molecules. In healthy persons, plasma volume remains relatively constant as a result of tight regulation by the complex interaction between neurohormonal systems involved in sodium and water homeostasis. Although chronic heart failure (CHF) is characterized by activation of many of these neurohormonal systems, few studies have evaluated plasma volume in this condition under treatment. Untreated edematous decompensated heart failure (HF) is associated with a significant expansion of plasma volume. Patients with stable CHF, receiving conventional therapy, appear to have a contracted plasma volume, a concept that is in contrast to the widely held belief that CHF is associated with long-term hypervolemia. It is likely that significant changes in plasma volume occur during intensification of medical therapy or during transition from the edematous to the stable state. Clinical assessment of plasma volume may be of particular value during treatment in patients with decompensated HF, in whom the plasma volume is contracted despite an increase in total extracellular fluid volume. Under these circumstances, treatment with inotropes or renal vasodilators may be more appropriate than intravenous diuretics alone. Further studies evaluating plasma volume in HF may help to improve our understanding of the pathophysiologic mechanisms occurring in the development and progression of this complex condition.

Abbreviations and Acronyms   ANP   atrial natriuretic peptide   CHF   chronic heart failure   cpm   counts/min   ECF   extracellular fluid   HF   heart failure   125I-HSA   human serum albumin labeled with radioactive iodine   PV   plasma volume   SNS   sympathetic nervous system

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